Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma

Christopher Kuo; Jemily Malvar; Yueh-Yun Chi; Eugene S Kim; Rachana Shah; Fariba Navid; James E Stein; Leo Mascarenhas

doi:10.1002/cam4.6491

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma

Cancer Med. 2023 Oct;12(20):20231-20241. doi: 10.1002/cam4.6491. Epub 2023 Oct 6.

Authors

Christopher Kuo^{1

2}, Jemily Malvar¹, Yueh-Yun Chi^{1

2}, Eugene S Kim^{2

3}, Rachana Shah^{1

2}, Fariba Navid^{1

2}, James E Stein^{2

3}, Leo Mascarenhas^{1

2}

Affiliations

¹ Department of Pediatrics, Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.
² Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
³ Department of Surgery, Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.

Abstract

Background: Thoracotomy is considered the standard surgical approach for the management of pulmonary metastases in osteosarcoma (OST). Several studies have identified the advantages of a thoracoscopic approach, however, the clinical significance of thoracotomy compared to thoracoscopy is yet to be evaluated in a randomized trial.

Aims: The primary aim was to determine the survival outcomes in OST patients based on surgical approach for pulmonary metastasectomy (PM) and secondary aim was to assess the post-operative morbidities of OST PM through various surgical approaches.

Materials and methods: We conducted a single institution retrospective study to compare survival outcomes and surgical morbidity according to the surgical approach of the management of pulmonary metastases in patients with OST.

Results: Sixty-one patients with OST underwent PM. Twenty-one patients were metastatic at diagnosis and underwent PM during primary treatment; nine had thoracotomy, six thoracoscopy, and six combined thoracoscopy with thoracotomy (CTT). Forty-three patients with first pulmonary relapse or progression underwent PM; 18 had thoracotomy, 16 thoracoscopy and nine CTT. There was no difference in survival between surgical approaches. There were significantly more postoperative morbidities associated with thoracotomy for initial PM (pain and postoperative chest tube placement), and for PM at first relapse (pneumothoraces, pain, Foley catheter use and prolonged hospitalizations).

Conclusion: Our study demonstrates that patients with OST pulmonary metastases have comparable poor outcomes despite varying surgical approaches for PM. There were significantly more postoperative morbidities associated with thoracotomy for PM. Surgical bias and other competing risks could not be assessed given the limitations of a retrospective study and may be addressed in a prospective trial evaluating surgical approach for PM in OST.

Keywords: osteosarcoma; pulmonary metastasectomy; thoracoscopy; thoracotomy.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Bone Neoplasms* / pathology
Bone Neoplasms* / surgery
Child
Humans
Lung Neoplasms*
Metastasectomy* / adverse effects
Morbidity
Osteosarcoma* / pathology
Osteosarcoma* / surgery
Pain
Prospective Studies
Recurrence
Retrospective Studies
Thoracotomy / adverse effects
Young Adult